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Infertility Treatment and Medications

Kısırlık Tedavisi ve İlaçlar

The treatment of the Infertility depends on the cause of infertility, how long the patient has infertility, the age of the patients and many other personal specifications. Some causes of the infertility are untreatable. Yet still, it is possible to get pregnant using assisted reproductive techniques.

Treatment for Couples: In this approach, both woman and man can be involved with the treatment. Increasing the amount of sexual intercourse to 2 or 3 times per week can increase the chance of pregnancy. But over ejaculation might reduce the quality of the sperm. The sperm can live up to 72 hours in a woman’s reproductive system and after the ovulation, fertilization can occur in up to 24 hours.

Treatment for Men:

  • General Sexual Problems: Diagnosing the premature ejaculation or erectile dysfunction can increase the chance of pregnancy. The treatment for those problems is usually medication or behavioral approach.
  • Lack of Sperm: If there is a suspicion for lack of sperm, hormonal treatments, assisted reproductive techniques or surgery can be an option. For example, in an event of varicocele, it can be usually treated with a surgical operation. In an event of retrograde ejaculation or a blockage preventing normal ejaculation, healthy sperm can be collected from the testicles and injected to the egg using microinjection techniques.

Treatment for Women: For the infertile women experiencing ovulation problems, fertility drugs are the most common treatment. These drugs regulate and promote ovulation. Usually, they work similarly to natural hormones like FSH and LH. The common fertility drugs are :

  • Clomiphene Citrate: This medicine is taken orally and it aims to stimulate ovulation in women with polycystic ovary syndrome or other ovulation problems. It aims to promote the pituitary gland to create FSH and LH hormones.
  • Human Menopausal Gonadotropin (hMG): This medicine is injected to women who are unable to ovulate because of the defection of the pituitary gland. On the contrary of Clomiphene which stimulates the pituitary gland, hMG and other gonadotropins are directly stimulates the ovaries. This medicine contains both FSH and LH inside.
  • FSH or Follicle Stimulating Hormone: This hormone stimulates the growth of ovarian follicles in the ovary.
  • Human Chorionic Gonadotropin (HCG): It is used along with Clomiphene, hMG, and FSH aiming to stimulate the ovaries to release an egg.
  • Gonadotropin-Releasing Hormone (Gn-RH) Analogues: This drug is used on women who have an irregular ovulation function or prematurely ovulating women during hMG treatment.  Gn-RH analogues constantly send Gn-RH to the pituitary gland.
  • Aromatase Inhibitors: Drugs like Letrozole (Femara) and Anastrozole (Arimidex) are approved drugs for treating breast cancer. Doctors sometimes administer these drugs to women who cannot ovulate naturally and does not respond well with Clomiphene Citrate treatment.
  • Metformin (Glucophage): This drug is administered if there is known insulin resistance or suspecting infertility in order to support ovulation. The insulin resistance can also be an actor of polycystic ovary syndrome.
  • Bromocriptine (Parlodel): This drug is used for women with an irregular ovulation function due to high prolactin levels. Bromocriptine limits producing prolactin.

Fertility Medication and Risk of Multiple Pregnancy: Fertility drugs used as injection increases the risk of multiple pregnancies. Oral medication like Clomiphene also increases the risk of multiple pregnancies but lesser compared to other drugs. The patient must be under control using blood tests, hormone tests and ultrasound (in order to determine follicle growth) while using these drugs. In general, the greater the number of fetuses, the higher the risk of preterm birth. Premature babies may experience health and developmental problems. These risks are higher on triple births. The risk of multiple pregnancies can be reduced. If the patient needs HCG in order to stimulate ovulation and if excessive follicle growth was seen in the ultrasound, patient and the doctor can decide to stop the HCG treatment. However, for most couples, the desire for pregnancy can get ahead of the risk of multiple pregnancies. In Multiple Pregnancies, reducing the number of fetuses can increase the chance of remaining fetus or fetuses. This situation creates moral and emotional problems for couples.

Surgery:  Depending on the situation, infertility can be treated with surgery. Blockages and other tube-related problems are usually treated with surgery. It is possible to perform delicate operations using Laparoscopic techniques. Infertility caused by endometriosis is usually harder compared to others. Although, hormones in birth control pills can be effective in controlling the pain and helping the treatment even though they are not used for infertility treatment. If you are diagnosed with endometriosis, your doctor can apply a treatment which birth control pills regulate ovulation or IVF treatment which basically aims to meet the egg and sperm in a controlled laboratory environment and injection of the created embryo in the uterus.

Assisted Reproductive Techniques: Assisted Reproductive Techniques are a revolution on infertility treatments. In Turkey, thousands of couples use these techniques in order to have a baby. After many medical improvements, today a lot of couples can have their biological children. The team behind the Assisted Reproductive Techniques are consist of doctors, psychologists, embryologists, laborants, nurses and medical professionals. The most commonly used Assisted Reproductive Techniques are:

  • In Vitro Fertilization (IVF): IVF is the most effective assisted reproductive technique. The healthy eggs are harvested from the woman and put together with the healthy sperms harvested from man. 3 to 5 days after the fertilization, embryos are placed in the uterus. In situations which both tubes are clogged, IVF is strongly recommended. IVF is widely used in the event of endometriosis, unidentified infertility, cervix related infertility, ovulation disorders and infertility caused by men. With IVF, risk of multiple pregnancies is increased because usually several embryos are transferred to the uterus. During the treatment, blood tests and hormonal levels are frequently checked.
  • Electro or Vibration stimulation for Ejaculation: This treatment aims to harvest healthy sperms. It is commonly used with patients who suffer from spinal injuries or man who cannot ejaculate naturally.
  • Harvesting Sperms With Surgery: This technique is used on men who suffer from a clogged sperm canal. This technique aims to harvest sperm from testicles using surgery.
  • Microinjection (ICSI): Like the IVF treatment, this treatment aims to inject the sperm into the egg. Microinjection can be applied to couples who cannot achieve pregnancy with other treatments. Microinjection increases the success rate in the event of low sperm count on men.
  • Assisted Hatching: This technique helps an embryo to attach itself in the uterus. It can be helpful in repeated failures with other techniques.

In situations when a woman has a healthy uterus, has a positive response to fertility drugs and ovulates naturally, assisted reproductive techniques has the highest chance of success. For the men, there must be healthy sperms too. After the age of 35, the success rate starts to drop.

Complications of the Treatment:

During the treatment, the following complications may occur:

  • Multiple Pregnancy: It is the most common complication. The couple decides how many embryos to remain. If there is a lot of embryos, removing 1 or 2 of them can increase the chance of remaining embryos.
  • Over Hyperstimulation Syndrome (OHSS): If the eggs are stimulated more than enough, they can grow more than they should and cause pain. Mild to medium symptoms can disappear without any treatment but pregnancy can delay the healing process. Rarely, the fluid builds up the abdominal and chest cavity and causes abdominal distension or shortness of breath. In severe cases, emergency treatment might be needed. Young patients who suffer from polycystic ovary syndrome have a higher chance of having OHSS compared to other women.
  • Bleeding and Infection: In every invasive procedure including the assisted reproductive techniques, there is a risk of bleeding and infection.
  • Low Birthweight: The biggest cause of Low birth weight are multiple pregnancies.
  • Birth Defects: There are several concerns between assisted reproductive techniques and birth defects. But, there are more researches needed to confirm these concerns.
Bu yazılarıda okuyun: « The Diagnosis of Infertility

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